In the state of Pennsylvania, acupuncturists are required to obtain a physician's referral from each patient within 60 days of the initial acupuncture visit. The physician's referral note must be from a DO or MD only. The referral should state the diagnosis and reason for the referral, the date of your most recent medical examination, and if there are any restrictions to the acupuncture treatments.

Please make arrangements to obtain this necessary paperwork from your doctor. You can use the referral form below or your doctor can use his or her own form/prescription pad.

Referral fax form for Knead.

Download Referral
Referral PDF Document